You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.
Leads the Claim Quality Review process in partnership with Claims LOB leads. Through collaboration with lines of business and quality review team, identifies trends and partners to create strategy of improvement. Manages team of claims quality reviewers and ensures common approach to quality best practices and guidelines across claims. Takes a creative approach to improving quality measurements, approaches and strategies with the goal of creating a culture of quality across the claims organization with accountability to maintain and update the associated tools and resources, including the technology platform. Through collaboration with the Quality team and the lines of business, identifies trending of strengths and gaps across Claim. Ensures common approach to quality best practices / guidelines across Claim where there is consistency in practice and desired behaviors. Ensures accurate and timely data is reported and distributed to Claim leadership.
JOB DESCRIPTION:
Essential Duties & Responsibilities
Performs a combination of duties in accordance with departmental guidelines:
- Leads the claim quality review team and process to ensure reviews are conducted accurately, timely and consistently in order to determine trends.
- Has full management accountability for direct reports with an emphasis on talent management and succession planning in accordance with corporate strategic direction.
- In collaboration with the lines of business, ensures relevant and accurate data, trends and insights are reported to Claim leadership for efficient, effective and engaging use with the goal of improving quality results.
- Develops new approaches to quality metrics, file selections and unique approaches to measure quality within claims files.
- In collaboration with the lines of business and quality review team, reviews Claim Opportunity Review (COR) / Management Claim Opportunity Review (MCOR) reports and other relevant inputs for trending, calibration and organization-wide insights. Participates in strategic creating of quality improvement plans and holds teams accountable for necessary improvements.
- Ensures a common approach to questionnaires, and best practices / guidelines across the lines of business where there is consistency in practice and desired behaviors. Process owner to implement measures to improve calibration between claims and claims quality as well as claims managers and claims handlers.
- Works in collaboration with the lines of business and Claim leadership to create a culture of continuous improvement where our people own quality, compliance and learning excellence.
- Provides leadership and coordination of resources for quality review programs: regulatory reviews, SOX compliance, Claim Operations, Third Party Administrators (TPA), other quality reviews and ad hoc audit requests.
- Stays current on trends and developments within the insurance industry.
May perform additional duties as assigned.
Reporting Relationship
Typically AVP or above
Skills, Knowledge & Abilities
- In depth knowledge of the insurance industry, its practices and operations; technical expertise in multiple lines of business.
- In depth knowledge of quality procedures, principles and tools and broad knowledge of system and technology alternatives as well as strong knowledge of related products and services.
- Ability to effectively lead, coach and motivate staff and project teams at all levels.
- Ability to exercise professional judgment and assume responsibility for decisions which have an impact on business goals, people and expense.
- Ability to effectively interact and build trusting and collaborative partnerships with all levels of internal and external business partners within scope of responsibility, team and/or matrix environment.
- Excellent written and verbal communication and presentation skills, including the ability to communicate business and technical information effectively.
- Excellent analytical and problem solving skills. Demonstrated creativity in resolving unique and challenging business problems.
- Ability to build credibility quickly and influence others.
- Ability to drive and achieve results, with ability to manage multiple projects to meet both short and long range goals and objectives.
- Strong computer skills including Microsoft Office Suite and other business related software systems.
Education & Experience
- Bachelor’s degree or equivalent.
- Typically, a minimum of ten years of related and progressive work experience, with a minimum of three year’s recent management experience.
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